Severe anal ulceration secondary to Histoplasma capsulatum in a patient with HIV disease

Severe fungal infections have become increasingly common in the immunocompr omised patient, including those infected with human immunodeficiency virus. Histoplasma capsulatum occurs in about five per cent of acquired immunodef iciency syndrome patients in the endemic areas of the Mississippi and Ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough lab oratory evaluation for opportunistic infections. Thus, surgeons play a crit ical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, pres entation, diagnosis, and treatment.